426215783-5-23-2019-17-CC-GRES-BCFT7Y-20190523142931

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426215783
Report Date: 05/21/2019
Date Signed: 05/23/2019 02:30:01 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	PADILLA FCC AKA ANA'S FAMILY CHILD CARE		FACILITY NUMBER:	426215783
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	05/21/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Ana Padilla		TIME COMPLETED:	01:05 PM

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Licensing Program Analyst (LPA) Gigi Reyes conducted an announced Pre Licensing Inspection and met with applicant, Ms. Ana Padilla. The home was toured inside and out. There are 3 bedrooms and 21/2 baths. LPA observed age appropriate furniture and equipment, cribs, diaper changing station are in placed. The back yard is completely fenced. There are no bodies of water observed. Applicant stated there are no guns nor ammunition in the home. Home is clean and free of any hazardous items. Formal living room, kitchen, bedrooms and garage are inaccessible to children in care.

CPR and First Aid expires in 4/4/2021, Preventive Health was completed on April 13, 2019. AB 1207 Mandated Reporter Training was taken on 5/11/2019. Fire Extinguisher was purchased on 5/21/2019. Home has working dual carbon monoxide and smoke detectors. LPA verified the grant deed. All adults living in the home have criminal record clearance.

Applicant is not providing Incidental Medical Services (IMS), IMS policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417.

Continued on 809 C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: PADILLA FCC AKA ANA'S FAMILY CHILD CARE	FACILITY NUMBER: 426215783
	VISIT DATE: 05/21/2019

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When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA provided Pre-licensing packet to applicant, reviewed and issued updated samples of state required forms to be posted and retained in each child’s file. LPA reviewed and provided applicant with a copy of “Child Care Providers Guide to Safe Sleep", “Effects of Lead Exposure” to be distributed to all families. Applicant was reminded that it is her responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov.

The home meets Title 22 Division 12 requirements for Small Family Child Care home, license is effective today, 5/21/2019.

LPA observed applicant posted the Notice of Site Visit.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019

LIC809 (FAS) - (06/04)

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